Billings Community Education Online Medical Classes | Advanced Medical Coding Chapter 8
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Advanced Medical Coding Chapter 8

06 Aug Advanced Medical Coding Chapter 8

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Advanced Medical Coding Chapter 8
Question 1 of 6
Question #1: OPERATIVE REPORT, TOTAL KNEE ARTHROPLASTY
LOCATION: Inpatient, Hospital
PATIENT: Sandra Bowie
SURGEON: Mohomad Almaz, MD
ATTENDING PHYSICIAN: Mohomad Almaz, MD
PREOPERATIVE DIAGNOSIS: Medial compartment and patellofemoral component osteoarthritis, left knee. Posttraumatic varus deformity, left proximal tibia.
POSTOPERATIVE DIAGNOSIS: Medial compartment and patellofemoral component osteoarthritis, left knee. Posttraumatic varus deformity, left proximal tibia.
PROCEDURE PERFORMED: Left cemented Duracon total knee arthroplasty
COMPONENTS UTILIZED: Duracon medium femur, M1 tibia, 16-mm (millimeter) posterior stabilized tibial insert, and 20-mm symmetric patella
OPERATIVE PROCEDURE: After suitable general anesthesia had been achieved, the patient's left knee was prepped and draped in the usual manner. Prior to prepping, a thigh tourniquet was applied. Initially this was not inflated. A long anterior midline skin incision was made. Long anterior capsulotomy was performed. Capsular bleeders were cauterized, as were skin and synovial bleeders. The tourniquet was then inflated to 300 mmHg after the leg was stripped with an Esmarch. Entry hole was made in the distal femur. Intramedullary alignment device was used to make the distal cut; 10 mm of bone was resected. Anterior referencing instrument was used. The anterior shim cut was made. Proximal tibial cut was performed. Due to the ramus deformity of the proximal tibia from a previous fracture, about 2 mm of bone was excised medially and about 12 mm laterally. This corrected the varus deformity. The extension gap was then checked. It was felt that a 13-flexion gap would provide an equivalent degree of tightness. This flexion gap was measured. The femur was then sized, and it was felt that a medium femur would reproduce this flexion gap. The 4-in-1 block was applied. Anterior posterior chamber cuts were performed. Trial femoral and tibial prosthesis were performed. The patient was noted to have some increased laxity and flexion. To tighten this up further, 2 mm of bone was excised off the distal femur. Inserter was upgraded to 16 mm, and with this there was good stability and flexion in extension and good alignment. The patella was then prepared for resurfacing technique. The patient had severe wear laterally, so 8 mm of bone was excised; 29-mm symmetric trial component was placed. This tracked well with the hands-off test. Box was then cut in the femur for the posterior stabilized component. Slot was cut in the tibia for the keel of the tibial component. Rotation of the tibial component was taken off of the medial third of the tibial tubercle. The joint was then thoroughly irrigated. Lug holes were then filled with bone graft from the bone trimmings. The M-1 tibia, medium femur, and 29-mm patella were then inserted; 60-mm insert was then placed and the leg held in extension until the cement was hard. Trial insert was then removed. The cement was carefully removed from the margins of the prosthesis. The actual 60-mm posterior stabilized tibial insert was placed. Locking screw was placed. The knee joint was then thoroughly irrigated. Capsule was closed with #1 Panacryl, subcutaneous tissue with 2-0 Vicryl, and skin with staples. A dressing and a Robert Jones dressing with anterior plaster splint were then applied. The tourniquet was released. Following tourniquet release, good circulation was noted to return to the foot. The patient tolerated the procedure well and returned to the recovery room in stable condition.
Please note that 1 g (gram) of vancomycin was added to each batch of cement due to the fact that the patient had had previous methicillin-resistant Staphylococcus aureus osteomyelitis of her foot.

SERVICE CODE(S): ___________________________________________________
ICD-10-CM DX CODE(S): ______________________________________________

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